CAJ | 학술논문

目的总结心外膜永久起搏器在儿童及婴幼儿中的应用,评估其可行性及安全性.方法复旦大学附属儿科医院2005年7月至2014年6月对18例高度房室传导阻滞的儿童及婴幼儿植入心外膜永久起搏器,其中男11例,女7例;年龄最小4个月,最大7岁;平均体质量(13.3±5.8)kg;11例为先天性心脏病手术后引起的房室传导阻滞,其余7例植入前未行心脏手术.回顾性分析该组病例的数据资料,分析心外膜永久起搏器的外科手术植入情况、术后随访患儿病情、并发症发生情况以及起搏参数变化.结果 18例患儿中有15例植入单腔起搏器,3例植入双腔起搏器,共植入21根电极.植入途径均采用经胸部正中切口路径,电极连接至右心室或右心房,手术均顺利完成.脉冲发生器置于患儿左侧腹部皮下,心外膜电极做充分的预留长度,以适应小儿的生长发育.术后平均随访32.2个月,所有18例患儿无死亡病例,1例发生电极断裂,1例手术伤口感染发生;起搏阈值、感知参数及电极阻抗均正常.结论由于心脏畸形,年龄及生长发育的关系,心外膜起搏器是儿童及婴幼儿永久起搏治疗的首选.我们的研究表明植入心外膜电极是可行且安全的,且操作简单,并发症少.
목적 총결심외막영구기박기재인동급영유인중적응용,평고기가행성급안전성.방법 복단대학부속인과의원2005년7월지2014년6월대18례고도방실전도조체적인동급영유인식입심외막영구기박기,기중남11례,녀7례;년령최소4개월,최대7세;평균체질량(13.3±5.8)kg;11례위선천성심장병수술후인기적방실전도조체,기여7례식입전미행심장수술.회고성분석해조병례적수거자료,분석심외막영구기박기적외과수술식입정황、술후수방환인병정、병발증발생정황이급기박삼수변화.결과 18례환인중유15례식입단강기박기,3례식입쌍강기박기,공식입21근전겁.식입도경균채용경흉부정중절구로경,전겁련접지우심실혹우심방,수술균순리완성.맥충발생기치우환인좌측복부피하,심외막전겁주충분적예류장도,이괄응소인적생장발육.술후평균수방32.2개월,소유18례환인무사망병례,1례발생전겁단렬,1례수술상구감염발생;기박역치、감지삼수급전겁조항균정상.결론 유우심장기형,년령급생장발육적관계,심외막기박기시인동급영유인영구기박치료적수선.아문적연구표명식입심외막전겁시가행차안전적,차조작간단,병발증소.
Objective To evaluate the feasibility and safety of permanent epicardial pacing in infants and children.Methods From July 2005 to June 2014,the clinical data were collected and analyzed for 18 children undergoing permanent epicardial pacemaker implantation at our cardiovascular center.There were 11 boys and 7 girls with an age range of 4 months to 7 years and a mean weight of 13.3 ± 5.8 kg.And 11 cases were diagnosed as atrium-ventricle block (AVB) after operations for congenital heart disease (CHD) while another 7 cases had no heart surgery.And their operative records and parametric changes during implantation were retrospectively analyzed.Results Among them,VVI (single chamber,n =15) and DDD (dual chamber,n =3) permanent epicardial pacing leads were implanted.Implantation was completed via midline thoracotomy and all surgical epicardial electrode leads were successfully implanted on right atrium and right ventricle.Pulse generators were placed in abdominal wall in a subcutaneous or submuscular pocket and pacing leads prepared for individual growth.No mortality occurred during an average follow-up period of 32.2 months.There were only lead fracture (n =1) and wound infection (n =1).Impedance,sensing and stimulation thresholds were all in normal ranges.Conclusions As a first-choice procedure for infants and children with severe AV conduction block,epicardial pacemaker is both safe and efficacious with fewer complications.